1245559657 NPI number — ESTES FAMILY CHIROPRACTIC AND WELLNESS CLINIC

Table of content: MS. SHARTRA SYLIVANT M.A., L.P.A. (NPI 1154529592)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245559657 NPI number — ESTES FAMILY CHIROPRACTIC AND WELLNESS CLINIC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ESTES FAMILY CHIROPRACTIC AND WELLNESS CLINIC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1245559657
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/25/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
702 GROVE ST
Provider Second Line Business Mailing Address:
SUITE 102
Provider Business Mailing Address City Name:
LOUDON
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37774-1481
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
865-657-9941
Provider Business Mailing Address Fax Number:
865-657-9942

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
702 GROVE ST
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
LOUDON
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37774-1481
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-657-9941
Provider Business Practice Location Address Fax Number:
865-657-9942
Provider Enumeration Date:
05/25/2010

Additional Information

Authorized Official

Authorized Official Last Name:
ESTES
Authorized Official First Name:
STEPHANIE
Authorized Official Middle Name:
A
Authorized Official Title or Position:
PROVIDER/CO-OWNER
Authorized Official Telephone Number:
865-657-9941

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  2383 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com